Do you have health insurance that covers all the medical bills when you have been hospitalized? Or do you have insurance like Medicare or some other health insurance that covers only part of your hospital bills? If you don’t have insurance coverage for some or all of your hospital bills—and you don’t have Medicaid or NJ FamilyCare—you may be eligible for the New Jersey Charity Care program to pay all or some of your hospital bills.
What does Charity Care cover?
If you are eligible, Charity Care will cover the costs of most hospital services that you receive in an acute care/general hospital in New Jersey. It will also cover the costs of hospital outpatient dialysis for people who are not eligible for Medicare. But there may be some doctors who treat you in the hospital who are not included in the Charity Care program, and they are allowed to bill you for their services.* If you have been found eligible for Charity Care but you get bills afterwards from doctors in the hospital, you should call the Legal Services office nearest you for assistance or LSNJ-LAW™, Legal Services of New Jersey’s statewide, toll-free legal hotline, at 1-888-576-5529.
Who is eligible for Charity Care?
To be eligible for Charity Care, you must meet all of the following requirements:
- Residency: You must show that you lived in the New Jersey at the time you received the hospital care and that you intend to remain living in New Jersey. Non-New Jersey residents can also apply for Charity Care if their health or life would have been at serious risk if they had not sought immediate medical care at a New Jersey hospital. There is no citizenship requirement for Charity Care eligibility, but you will have to provide proof of identity when you apply.
- Eligibility for Medicaid/NJ FamilyCare: You may have commercial insurance (individual or group insurance) or Medicare and still be eligible for Charity Care. Often, these types of health insurance do not cover all the costs of your hospital care. But you will not be eligible for Charity Care if you are eligible for Medicaid or NJ FamilyCare. The hospital can require that you apply first for Medicaid or FamilyCare to show that you are not eligible for these programs before the hospital can grant you Charity Care.
- Financial Eligibility: Both your income and the value of your assets must meet Charity Care limits. First, you will be eligible for full Charity Care coverage in 2007 if your annual gross income for the 12 months before your hospital care is not more than 200% of the federal poverty level, which is $20,420 in 2007 for a family of one person. If your annual income is more than 200% of the poverty level, but not more than 300%, or $30,630 in 2007, a portion of your hospital bill in 2007 will be covered by Charity Care. If your family size is larger—your family includes you, your spouse, any minor children you support, and adults for whom you are legally responsible—the income eligibility limit is higher. For example, an applicant in a family of four will be eligible for full Charity Care coverage in 2007 if the family’s annual income is $41,300 or less. And the applicant will still be eligible for reduced Charity Care coverage in a family of four with income that is greater than $41,300, if the income does not exceed $61,950.
If you provide the hospital with proof of your annual income for each of the 12 months before you received the hospital care, the hospital must calculate your annual income in three different ways and use the calculation for the period of time when your income was the lowest. This is how the hospital must determine your income eligibility for Charity Care:
- You may give the hospital proof of your gross income for each of the 12 months immediately before you received the hospital care and the hospital will use the total of the 12 months to decide your annual income;
- You may give the hospital proof of your gross income for the three months immediately before your hospital care, and the hospital will multiply the three months’ total by four to determine your gross annual income; and
- You may also give the hospital proof of your gross income in the month immediately before you received the hospital care, and the hospital will calculate your annual income by multiplying this amount by 12.
As you can see, if your income did not remain the same in each of the 12 previous months before you received the health care, you want the hospital to calculate your income with one of the alternate methods. Therefore, it is very important to provide the hospital with the proofs of income that allow them to make this decision in your favor.
Second, the value of your assets must meet the Charity Care limits. Assets are items that can be easily converted into cash. They include such things as savings and checking accounts, certificates of deposit (CDs), Individual Retirement Accounts (IRAs), trust funds, and equity in real estate that is not your primary residence. Charity Care eligibility limits the amount of assets that you may have but, if you own your own home, it will not count the value of the home you live in. The asset limit for one person is $7,500. And a family’s assets may not be greater than $15,000 as of the date of the medical care. To be eligible, you must submit a statement from a bank or other financial institution to show the amount of your assets. If you have no assets, you must submit a signed statement to the hospital that you have no assets.
What if I make too much money?
If your Charity Care coverage will pay for only a portion of your hospital costs because your income exceeds 200%, there is help to cover unpaid bills that are extremely large. If your medical expenses are greater than 30% of your family’s annual income, the amount greater than 30% will be fully covered by Charity Care. Children may also be eligible for coverage under New Jersey’s Catastrophic Illness in Children Relief Fund for very large hospital bills that are not covered by insurance. For information, call 1-800-335-FUND.
If your income meets the Charity Care limit but your assets are too high ($7,500 for an individual; $15,000 for a family), you may spend down your assets on the unpaid hospital bill until your assets are within the Charity Care limit. This can make you eligible for Charity Care coverage for the rest of your bill.
When and where do I apply?
You must apply for Charity Care at the hospital where you received the medical care. When you apply, a hospital may accept your Charity Care determination from another hospital, but it is not automatic and one hospital does not have to honor another hospital’s determination of your eligibility. You can apply for Charity Care at the hospital’s business office or billing department.
You may submit a completed application for Charity Care up to a year from the date that you were discharged from being admitted as an inpatient at the hospital or a year from the date you received outpatient care at the hospital. The hospital may accept an application within two years of these dates, but it is not required to take an application past one year. That is why it is very important to apply for Charity Care as soon as possible after you receive the medical care.
Does the hospital have to give me Charity Care if my income is low?
If the hospital thinks you may be eligible for another public benefit program to pay for your hospital bill, like Medicaid or NJ FamilyCare, the hospital will refer you to apply for that program. If you do not apply for the other public benefit program within three months, the hospital may bill you for the cost of your hospital care. But if the hospital never informs you that you can apply for Charity Care, Medicaid, or NJ FamilyCare to cover the cost of your care, the hospital must cancel your hospital bill as a courtesy and cannot bill you.
For more information…
For more information about eligibility for New Jersey’s Charity Care Program, please see the handbook, New Jersey’s Charity Care Program: Finding the Answers on Charity Care. If you have been denied Charity Care or you would like legal help because you are being billed for medical care, please contact your regional Legal Services office (see the list of New Jersey Legal Services programs on page 10) or call LSNJ-LAW™ at 1-888-LSNJ-LAW (1-888-576-5529). The hotline is open Monday through Friday, 8 a.m. to 5:30 p.m.
*Some doctors’ bills are not covered by hospital Charity Care because doctors contract with the hospital for their services, and they are not employed by the hospital.
This article originally appeared in the May 2007 issue of Looking Out for Your Legal Rights® |
